This is Brent and in this video we're going over ankle mobilization. I'm very
excited about this video as well as the next several videos in this series,
because as you guys have probably started to realize, movement impairment, postural
dysfunction, improving the quality of human movement takes more than just
looking at muscles. There's joints involved, there are arthro-
kinematic motion as well as arthrokinematic dysfunction to think about. Now
self-administered joint mobilizations have always been a gap in our exercise
selection. It's been very hard to find techniques that were effective as well
as easy to teach and safe. Now luckily we've had some very creative individuals,
we've had some very innovative techniques all of a sudden come in. We
have guys like Kelly Starrett who's using these monster bands to create all
sorts of changes in arthrokinematic motion. Now his techniques are a little
extreme for my taste it might just be the populations that we work with, but
then after talking to my friends Pete Schultz and Aaron Swanson over at dynamic
sports physical therapy, I realized there was some ways to regress this stuff. I
got a chance to work with it a little bit myself and add my little twists
based on my thinking of dysfunction, and all of a sudden we have a set of very
easy, very safe, very practical techniques that my personal trainers can use with
their clients, as well as my ATC's PT's and DC's can now add to home exercise
program so all of that mobility you've been working for in joints, is kept from
session to session. I'm going to have my friend Melissa come out, she's going to
help me demonstrate. Now before we even start thinking about what we should do
to the ankle we have to think about what is happening at the ankle in dysfunction,
which is we have the the calcaneus, the heel bone, the tail is stacked on top of
it and then the tibia on top of that. Now in lower leg dysfunction dysfunction in
this area, the talus has a tendency to switch anteriorly, try to get stuck
anteriorly which then blocks the tibia and the calcaneus from being able to tip
into dorsiflexion. It's like a mechanical block. Some of you guys have probably
felt that when you go and do a calf stretch and you actually feel it more of
like a pinching or pressure in the front of your ankle. The other thing that
happens to talus is it starts shifting medially,
which creates that foot flat thing we see in so many individuals. So we have to
do for our mobilization let's find a way to work on dorsiflexion which is that
range of motion that's commonly lost, while trying to shift the talus that
way. Right it's stuck this way we want an anterior to posterior pull. Now my
problem with some of the mobilizations I've seen in the past is in order to get
room for the talus to shift, you kind of need to create some distraction in
the ankle. Now we might not be able to do that all that well with
self-administered techniques, but previously I've seen a lot of people try
to stand on this leg, they put pressure through the tibia through the talus,
through the calcaneus, and compress the talus and then they try to do the
mobilization, and it just doesn't work because there's no room. Like I said this
is where I went to dynamic sports physical therapy and Aaron Swanson was
all of a sudden doing this technique raised up on a step, and I kind of
realized the genius that was happening here. Now Melissa has to put the weight
on her back leg, this is unweighted. So at the very least I have no more
compression and when she drives into dorsiflexion, I'm hoping that this big
monster band will give me enough force to keep the talus in place just like
if I had put my hand here over the neck of the talus. So getting back into
setup now, she's put this nice thick band just below her lateral and medial
malleolus. Alright so just below those so the band kind of ends up on the angle
right here of the ankle which is on the neck of the talus, she's going to
shift her foot forward and get some good some good pull. I'm going to go ahead and
give her a dowel or a foam roll or something, so that she can maintain her
balance. She's going to try to keep her back leg underneath her body. Remember I
want this leg taking on all the weight, if that leg gets way back behind her
she's going to have to switch weight on this leg and then we have
the compression problem again. Now we can get really fancy here not only use this
dowel for balance, but put it between the second and third toe, put it a few inches
maybe four or five inches in front of her knee, and now not only does she have
something nice to balance with, but if I tell her to drive forward with her left
glute, so I'm working on a right ankle, her left glutes going to actually be
doing the work, I can have her work on dorsiflexion trying to get to that stick
which is not so easy. Alright let's try 15 to 20 reps of that, it's usually the
rep range I've been working on lately. 15 to 20 reps making sure she keeps her
heel down, if she doesn't keep her heel down we're not working on dorsiflexion
anymore. I keep that heel down and she's got this huge posterior pull.
Now you can start applying I know my PT's out there, my ATC's out there, my DC's
out there, we're all taught our mobilizations our grade ones, grade 2's,
grade 3's, grade 4's, it would be a little too much for me to say that we could
replicate that here. But you guys could go from these larger amplitude movements
to like let's say she has no pain she's just really stiff, maybe I can get her
into end range and then just have her oscillate, right like we were taught to
and our mobilizations in school just one to two oscillations per second for
30 seconds, and maybe that's how I'm going to do this technique. So now you
guys got two options; we can go through a full range of motion and she can use the
stick as the goal, or we can take her to her end range and just try to oscillate
a little bit. If she was somebody who was having pain I do want to warn you guys
with this, let's say she has ankle impingement, we only want to touch that
pain. We don't want to go into that painful range. Just touch it, because the
last thing I want to do is take a nice inflamed ankle and make the inflammation
and the pain worse. We definitely don't want to do that because it's going to
change your gait, it's not going to help her move better,
I would still use this technique, I would just say let's say she starts feeling a
pinch right here, well good, I would have her set that stick back, I just want you
to touch the pain, don't go into it, don't make it worse,
and then she's going to back off it. Alright so we're still getting work on
that anterior to posterior mobilization, but through a range of motion that's
pain free. Alright guys so I want you to work with that, let me have you go ahead
and switch sides so they can see that you're putting all of the weight on the
other leg. Just want to see you guys see both sides of this set up, and then we'll
show you the medial to lateral pull on the talus because it's the same thing.
What I want you guys to notice is she set up nice and tall, good kinetic chain
checkpoints, her shoulders are over her hips, her foots beneath her, and
then I'm going to have her squeeze this glute and really think about squeezing
this glute so that she does not start loading this leg, which is going to add
the compression and make that mobilization a little harder. Once again
we can do those larger amplitude movements, we can do the smaller
oscillations at end range. Or if she had a little pain in her ankle we could go
just up to the painful area and back, trying to help with ankle mobility
without exacerbating that pain. Alright the next technique I'm also really
excited about which is a medial to lateral mobilization. So we got to switch
around here make sure they don't trip over the band,
thank you. No other way, so you can, there we go,
good. Now I know what you guys are thinking
that we probably go mediolateral and start rocking back and forth this way, but that
actually does not work out very well. You guys are going to get a medial to
lateral force just like you see. I'm going to have her step out just a little
bit that way, put the stick in this hand between our second and third toe. I
actually kind of like a little bit of abduction here so that the tibia is
slightly internally rotated, and then they're working on keeping their first
MTP, that ball just behind their big toe down on the floor. Alright this seems
to keep inversion. What I don't want to see is them all of a sudden flop into
eversion because just like compression won't let the talus move this way, if
all of the sudden i evert, all of the sudden now the talus can't move back into
position laterally. So I needed to stay inverted but with first MTP on the
ground, and then she's going to do the same thing, she's just going to do a
little dorsiflexion and work on talar mechanics but now in the frontal plane.
How does that feel, all the same stuff applies. Most of the weight is on this
leg, she can do larger amplitude movements, she can do the smaller
amplitude movements at the end of a range. Like I said if she had some pain
we would go just up to the point of pain working on good ankle mobility, without
exacerbating that dysfunction. Melissa thank you very much. I hope you guys
enjoy these techniques. Go out and grab some of these monster bands they're
really not that expensive. I know you guys can find steps in your club, a dowel,
few pieces of cheap equipment, and all of a sudden we fill a huge gap in our
postural dysfunction and self-administered technique model. I'll
talk with you soon.